Provider Demographics
NPI:1295075315
Name:MILLER, RONDA SUE (LMHC)
Entity type:Individual
Prefix:MS
First Name:RONDA
Middle Name:SUE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:RONDA
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:4995 49TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709
Mailing Address - Country:US
Mailing Address - Phone:727-827-7890
Mailing Address - Fax:727-279-4631
Practice Address - Street 1:4995 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709
Practice Address - Country:US
Practice Address - Phone:727-827-7890
Practice Address - Fax:727-279-4631
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 10761101YM0800X
FLMH13006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1457749145OtherNPI